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‫بسم هللا الرحمن الرحيم‬
The introduction
* The lower muscles are subdivided according to regional origin which
indicates the bone of lower limb that affected of muscle contraction into:
1. Muscles of gluteal region - that move the thigh
2. Muscles of the thigh - that move thigh & the leg bones (tibia and fibula)
3. Muscles of the leg - that move the foot and toes
* The posterior part of the hip is called the buttocks. There are inferior
buttock lines or gluteal folds which are the inferior borders of the gluteus
Maximus muscles.
* Inferior to the gluteal region anteriorly, there are anterior compartment of
the thigh, knee joint, anterior compartment of the leg dorsum of the foot. On
the other hand, posteriorly, there are the posterior compartment of the
thigh, popliteal fossa, the posterior compartment of the leg and the plantar
surface of the foot
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* This important figure shows anterior surface of thigh under the skin and
fascia. here you will find directly what we call it the "femoral triangle" .
* The femoral triangle has 3 boundaries which are
1. The inguinal ligament 2. Medial surface of Sartorius muscle (the tailor)
3. Lateral surface of the adductor longus muscle
* There are 3 structures pass through the femoral triangle: (N-A-V)
1. Femoral nerve 2. Femoral artery
3. Femoral vein (The medial)
* The femoral artery is easily accessible and palpable within the triangle and
it's the site for insertion the catheters.
* Immediately below the inguinal ligament there is tough lower border of the
Aponeurosis of external oblique muscle.
* The landmark for the indication the precise site of femoral artery and veins
in the femoral triangle is the anterior superior iliac spine. When you go
medially and inferiorly to this spine you will find the femoral artery and vein.
* The femoral triangle are covered by the fascia of the tensor fasciae latae
muscle which enough tough to make the femoral artery more palpable.
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* This figure shows popliteal fossa which has a rhomboid shape and 4
boundaries: superiorly by hamstrings muscle (semimembranosus and
semitendinosus) and inferiorly by the bifurcated gastrocnemius muscle.
* The structure that pass through the popliteal fossa (N-V-A)
1. The branches of the sciatic nerve which are the tibial nerve and common
fibular nerve
2. Popliteal vein
3. The popliteal artery (the continuation of the femoral artery) (THE MEDIAL)
* The muscles of the lower limb are divided in muscular compartments with
different functions
1. Gluteals in the posterior pelvis – extend, abduct, and rotate thigh
2. Anterior compartment thigh - flex thigh, extend leg (extensors)
3. Posterior compartment thigh – extend thigh and flex leg (flexors)
4. Medial / adductor compartment - adduct and medially rotate
* We call the muscle by "extensor" or "flexor" according to its action on leg
*we call the medial muscles as "glutei antagonists" because these muscles
adduct thigh whereas the glutei abduct the thigh
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The figure above shows the thigh muscles in cross section and the corresponding
function or movement that each one it makes
- The thigh is flexed or extended according to anterior angle between thigh and
abdomen
- When we say thigh extension, it's the same as the leg flexion and vice versa
- Dorsum of the foot is the superior surface of it, whereas the plantar surface is
the inferior surface of the foot
- At the ankle joint, when we do dorsi flex that means also the plantar extension
because it increases the angle between the plantar surface and the posterior
surface of the leg.
The gluteals muscles
1. The gluteus Maximus: very broad big muscle that forms the buttock
-this muscle practically extends from the posterior aspect of iliac fossa, go along
the way to the greater trochanter. It is ligated with the lateral protector of the
thigh which a lateral muscle is called tensor fasciae latae that comes from the
anterior superior iliac spine. Both gluteus Maximus and tensor latae contribute
to form the iliotibial fasciae of the thigh after they are ligated inferiorly.
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* Iliotibial fascia extends to condyle of femur forming the iliotibial tract. From
this band or fasciae, attachments that go all over the places and hold all the
muscles exist.
* practically , the gluteal Maximus continues downward as iliotibial tract , and
the tensor fasciae latae muscle anteriorly will go all the way and insert into the
iliotibial tract
* Gluteus Maximus is big muscle and tend to be oriented toward the midline and
it covers 2 other muscle below it, which are the gluteus minimus and gluteus
medius
* Back to the pelvis girdle anatomy, there three lines called the gluteal line in
lateral surface of the ilium. These lines are the site where the glutei muscles are
originate.
* Indeed, the gluteus Maximus has a broad origin. It originate from the ilium
(posterior border of iliac crest where the gluteal lines present), from the sacrum
going on the way to the coccyx. The superior border of gluteus muscle is free.
When dissect this muscle, you discover that you can put your hand between it
and gluteus medius. The gluteus Maximus will insert into the gluteal tuberosity,
but it will continue down as iliotibial tract
* The gluteus Maximus extend, abducts and laterally rotate the thigh. It is
innervated by inferior gluteal nerve
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* As it is shown here, the tensor fascia latae originates from anterior aspect of
the crest. It will never reach the tip of anterior superior iliac spine because
external oblique muscle overlaps and over there the inguinal ligament begins.
*the tensor fasciae muscle goes down to the iliotibial tract which else continues
going down and blends with the lateral aspect of the knee joint that will form a
lateral reinforcement for the knee.
* Although both tensor fasciae latae and gluteus Maximus share the same
iliotibial tract but they don’t share same action.
* Although the tensor latae extends laterally, it is considered a muscle of
anterior compartment of the thigh because it has the same effect of them which
is flexion
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- here, both gluteus Minimus and medius are shown after the Maximus are
removed .The gluteus Minimus entirely are covered by gluteus maximums so it
cannot be seen without removal of Maximus .
- notice that both gluteus minimus and medius oppose the gluteus Maximus in
its action by doing medial rotation of thigh whereas gluteus Maximus does
lateral rotation of the thigh.
Deep gluteal muscles
1. Piriformis (pear-shaped)
* passes through the greater sciatic foramen and posterior aspect of the sacrum.
* It's a guide for nerves that come from the sacral plexus as sciatic nerve which
passes below piriformis
* Piriformis divides the external iliac artery into superior and inferior gluteal
artery. The superior gluteal artery will pass above the piriformis belly and the
inferior gluteal one will pass below the piriformis
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2. The obturator internus
* This muscle has a common tendon with 2 muscles one Is located below it and
the other is located above it : superior and inferior gemelli muscles
.
3. superior and inferior gemelli
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4. Quadratus femoris
- The quadrate tubercle is part of greater trochanter
Here is the sciatic nerve pathway, note that its branches present in one fasciae.
Also, superior and inferior gluteal arteries are present here.
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Posterior compartment of the thigh ( hamstrings )
- Hamstrings muscles includes : semitendinosus , semimembrosus and biceps
femoris .
- Semimembrosus muscle has smaller belly and very long tendon, whereas
semitendinosus has a bigger belly and long tendon
- Hamstrings muscles share the same origin from ischial tuberosity and insert
into the leg.
- The action of hamstrings: extend the thigh and flex the leg
- Hamstrings are antagonist of the quadriceps femoris because they have
opposite actions on the thigh and leg. That thing will reinforce the knee and
provide the stability against dislocation anteriorly or posteriorly.
* This is the biceps femoris muscle with two heads
- The long head originate from the ischial tuberosity
- The short head originate from the linea aspera of the femur
- Both heads of biceps femoris insert into the fibular head
- They are agonist of the gluteus Maximus because of the lateral rotation they
cause
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- Left side: this is the semitendinosus, it has long tendons from both sides of
the belly, this muscle originates from the ischial tuberosity and insert into the
tibial part (not fibular part as the biceps femoris)
- It mingle with Sartorius and gracilis in the medial condyle of the tibia
- It's called chief flexor of knee plus it has a lateral rotation action in the semi
flexed knee
- Right side : the semimembranosus , most of the muscle is flat with more
flatter tendon comes from the ischial tuberosity and insert into the medial
condyle of posterior surface of tibia (similar to semitendosus muscle)
- the action of this muscle is the same with the semitendinosus : knee flexion
and lateral rotation
Anterior compartment muscle at the hip
* these muscle originate from the pelvic region and vertebral column and pass
anterior to hip joint to cause the flexion of the thigh at the hip joint level
* this compartment include: iliopsoas muscle , Sartorius , tensor fasciae lata ,
rectus femoris , and the pectineus
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Notes:
*Quadriceps femoris include: rectus femoris and three vasti muscles
* Rectus femoris muscle is the only muscle of quadriceps femoris that
originates from the pelvis region. The others (vasti muscles) originate at the
thigh level
* Pectineus muscle is considered as a medial muscle (adductor), but it has a
secondary action which is the flexion of the thigh at the hip joint.
1. The iliopsoas muscle (iliacus + psoas major)
- iliacus muscle originates from the anterior medial surface of the ilium while
the psoas muscle originate from the vertebral body and transverse processes of
the lower lumbar till sacral vertebrae .
- Both muscle go together and insert into the same tendon that will continue to
insert into the lesser trochanter
- The iliopsoas muscle flexes thigh muscle in an opposite manner to that of the
posterior compartment of hip muscles (glutei muscle and the others)
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* A comparative figure shows the anterior and posterior compartments of the
hip and thigh musculature
2. Sartorius (the tailor)
* The longest muscle in the body originates from superior anterior iliac spine
and insert into the upper surface of the tibia medially to be part of the medial
surface of the knee where the hamstrings semitendinosus and
semimembranosus are inserted also.
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In the right side: this figure shows the anterior compartment muscles which are
called the extensor (acc to the leg extension)
The extensors muscles include quadriceps femoris in addition to Sartorius muscle
- The quadriceps femoris has four muscles (rectus femoris, vastus lateralis, vastus
medialis , vastus intermedius) with common tendon is called patellar ( ligament)
which insert into the tibial tuberosity .
- the common patellar ligament which is the continuation of the quadriceps
tendon.
- The patellar ligament reinforces the knee joint anteriorly.
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* As shown here: the common patellar ligament which is the continuation of the
quadriceps tendon.
Medial thigh compartment (adductors )
• Five muscles are located in the medial compartment of the thigh.
• Adduct the thigh and perform additional functions.
• Adductor longus, adductor brevis, gracilis, and pectineus also flex the
thigh at the hip joint
Adductor magnus extends and laterally rotates the thigh
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* These are the adductors of the thigh that are located medially to it
* These muscles originate either from pubis or ischium. No muscle originate
from the ilium
* The primary action of these muscle is the adduction of the thigh, but each
one has a secondary action (either flexion or extension of the thigh ).
* All of them (except adductor Magnus) flex the thigh at hip joint
* The adductor magnus has a canal is called adductor canal with a presence of
a hiatus
* The femoral artery passes through the adductor canal. And once it passes
its name change to be a popliteal artery .
The END of the lecture
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